Trends, patterns, and incidence rate of seasonal influenza among Dubai population and some associated factors, 2017-2-19

Research Article | DOI: https://doi.org/10.31579/2690-4861/109

Trends, patterns, and incidence rate of seasonal influenza among Dubai population and some associated factors, 2017-2-19

  • M. Ibrahim Gamal 1
  • Hamid Y. Hussain 1*
  • Wafa K. Alnakhi 1
  • Heba Mamdouh 1

1 Dubai Health authority, Strategy and corporate development sector, research- study and data analysis Dept, Dubai, UAE.

*Corresponding Author: Hamid Yahya Hussain, Dubai Health authority, Strategy and corporate development sector, research- study and data analysis Dept, Dubai, UAE.

Citation: M. Ibrahim Gamal, Hamid Y. Hussain, Wafa K. Alnakhi, H Mamdouh. (2021) Trends, patterns, and incidence rate of seasonal influenza among Dubai population and some associated factors, 2017-2-19. International Journal of Clinical Case Reports and Reviews. 7(1); DOI: 10.31579/2690-4861/109

Copyright: © 2021 Hamid Yahya Hussain, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 21 January 2021 | Accepted: 09 April 2021 | Published: 13 April 2021

Keywords: seasonal influenza; patterns; incidence rate; dubai population; associated factors

Abstract

Background: WHO estimates that seasonal influenza may result in 290 000-650 000 deaths each year due to respiratory diseases alone. In addition, affected more than 10% of total population annually worldwide, Seasonal influenza is highly contagious disease; spreads easily, with rapid transmission in crowded areas including schools and nursing homes. 
Objectives: To Study incidence rate, trends and patterns of seasonal influenza among Dubai population for the period 2017-2019, to Study some of the associated factors. 
Materials & Subjects: A retrospective records review study was carried out of convenience sample of 29158 confirmed seasonal influenza case reported in Emirate of Dubai for the period 2017-2019. All age groups, genders, nationalities, occupations, education and seasons were considered. 
Findings: The study showed that 53.42% of total seasonal influenza cases were among male groups in Dubai, almost 50% % of the cases were among age group less than 15 years old, and almost one quarter of cases were among the age group between 30-40 years old, the present study showed that 54.37% were among Asian groups, 14.59% of the seasonal influenza incidence in Dubai during 2017-2019 were among Emirati population and 18.79% were among Arabs groups .As per occupation, the study showed that 30.74% of total seasonal influenza cases were among students in Dubai, on the other hand the study revealed that 84.53% of the total seasonal influenza cases during 2017-2019 were handled at outpatient level, yet 15.47% were sever enough cases to be admitted and treated at inpatient facilities. Incidence rate per 100000 population were increased respectively from 2017 through out 2019 (168, 297,466). The study revealed as well that the rate as per nationality the seasonal influenza incidence rate in Dubai from 2017=2019 650/100000 among Jordanian living in Dubai,, almost 50% % of the cases were among age group less than 15 years old, and almost one quarter of cases were among the age group between 30-40 years old, the present study showed that 54.37% were among Asian groups, 14.59% of the seasonal influenza incidence in Dubai during 2017-2019 were among Emirati population and 19.71% were among Arabs groups .
The study showed that 30.74% of total seasonal influenza were students in Dubai, 84.53% of the total seasonal influenza cases during 2017-2019 were managed at outpatient.  yet 15.47% were sever enough cases to be admitted and treated at inpatient level of different health care facilities in Dubai. Incidence among Egyptian was 557/100000, while among Emirates, 325 /100000, Incidence rate of seasonal influenza 2017-2019 according to age distributions showed that 30.7%among students, and 7.8%among children preschool age, and 5.22%among housewives. The present study showed that the incidence rate of seasonal influenza in Dubai in 2017-2019 as per moth distributions was the highest, 21.4%in November followed by 18.2%in December, and the least was 2%in July.
Conclusions: incidence rate of seasonal influenza in Dubai keep increasing during the last three years, the highest rates significantly come from children segment of population specially students and elderly group as well, the period from October to end of February of each years.

Introduction

Seasonal influenza is highly contagious disease; easily and rapidly spreads, with high transmission rate in places with overcrowding and high population density. During last few years some figures reported about increasing of influenza incidence in Emirate of Dubai which needs to be carefully inspected and interpreted for policy decision making , and system intervention containment strategy. Influenzas are remarkable threat at global health function, almost affects every single country annually. WHO talked 1 billion incidence case globally at annual base, about 3-5 million cases with complications, hospital admissions and significant care utilization, the international figures telling of (290000-650000)-death event related to influenza- respiratory complications worldwide.  Since three years back, world health organization prepared plan to raise awareness of national health systems for potential influenza pandemic outbreak, stressed on a fact a pandemic wave is few steps far from the door [1].

World health organization lunched framework of Global strategy initiative on seasonal influenza for 2019-2030 , multiple countries and technical partners were enrolled , to proposing containing efforts to foreseen threatens. Comprehensive multi-dimensional and inter sectoral by means of vigorous national actions at level of surveillance, laboratory capacity development, public health measures and clinical management – through addressing and filling gaps to achieve optimum prevention and control level. The goal targeted goals remains as of strengthening seasonal control, preventions and preparedness for anticipated pandemics. In order to reaching similar target, necessities to developing global and national containment strategies, which places a large focus on the following: vaccines, as global tool strategy to be in the core of developmental steps, treatments by antiviral agents to benefit most of the countries and build public confidence, and investing in technical capacity uptake; of Stronger and integrated health functions inside universal health coverage efforts and national health security planning [2].

According to Centre for Diseases control and preventions (CDC), it has been estimated that annual influenza cases in United states of America has reached up to (9 million – 45 million illnesses), out of which, between (140,000 – 810,000 ) cases were admitted to hospitals every year and the account of death was ( 12,000 – 61,000 ) event yearly since the year of 2010.[3]. World Health organization reported that, seasonal influenza cause (290000-650000) deaths event annually because of to acute respiratory illnesses (ARI) and its consequences. Gaps still remain such as a lack of high quality and up-to-date estimates of severe influenza burden at global and regional levels, despite an increase in the number of countries investing extensively to inform prevention measures of influenza,; Somehow few numbers of middle and low -income countries (LMICs), managed to develop trustable national accounts of seasonal influenza (BoD burden of disease). The lack of reliable Burden of diseases data as well as the potential effect of vaccination among specific high-risk groups. Highlighting the scale of the influenza threats at regional, national and global level shall re-enforces the need for nations to take action to address their influenza disease burden. [4]

Seasonal influenza International studies showed that in UK, Influenza was responsible for an estimated 145000 deaths among all ages in 2017. The influenza LRTI mortality rate was highest among adults older than 70 years16•4 deaths per 100 000 [95% UI 11•6–21•9]) [5], while Saudi Arabia was H1N1 given an incidence rate of 3.5 per 1000. [6].

In UAE studies reported that influenza was the most frequently detected virus (273/1362 [20.0%]), followed by human rhinovirus (146/1362 [10.7%]). The influenza positivity rate showed two peaks, which occurred in August and December [7].

 It the context of Covid19 pandemic, the situation become more complicated, the burdens and damages made by covid18 at health m social and economic level .

 The current study is aiming at: 

To Study incidence rate, trends and patterns of seasonal influenza among Dubai population for the period 2017-2019. Top Study some of the associated factors.

Material and Methods:

A retrospective records review study was conducted on convenience sample of 29158 confirmed seasonal influenza case reported in Emirate of Dubai for the period (2017-2019). Secondary reported data was retained from private sector facilities in Dubai, All age groups, genders, nationalities, occupations, education and seasons were considered. Operational definition of confirmed seasonal influenza was adopted as laboratory diagnosis of influenza Virus (A & or B by PCR test and treated clinically as a case of seasonal influenza inpatient or outpatient clinic.

Exclusion and inclusion criteria was applied (all laboratory confirmed cases were included in the study), repeated cases within three months as infected again were excluded) the data sheet were excluded, a cases with inadequate information or unconfirmed diagnoses were all excluded from the recruitment process.

Data coding, entry, cleaning and data analysis was carried by using statistical package soft were SPPS21,.and R studio 95% level of significance and).05 P value was adopted.

Results

The current study showed that 53.42% of total seasonal influenza cases were among male groups in Dubai, almost 50% % of the cases were among age group less than 15 years old, and almost one quarter of cases were among the age group between 30-40 years old, the present study showed that 54.37% were among Asian groups, 14.59% of the seasonal influenza incidence in Dubai during 2017-2019 were among Emirati population and 18.79% were among Arabs groups.

As per occupation, the study showed that 30.74% of total seasonal influenza cases were among students in Dubai, on the other hand the study revealed that 84.53% of the total seasonal influenza cases during 2017-2019 were handled at outpatient level, yet 15.47% were sever enough cases to be admitted and treated at inpatient level of different health care facilities in Dubai. As shown by table (1) The present study revealed that incidence rate per 100000 population were increased respectively from 2017 through out 2019 (168, 297,466) as shown by figure (1), The study reflected that the incidence rate by age groups, the highest in the age group 2-5 years old 23.5/100000, age group 1-2 years 18.68%, and the age group 30-35 years old 9.1%. In addition, the least rate was among 55 years old, 0.99/100000.as shown in figure (2). The study revealed as well that the rate as per nationality the seasonal influenza) 14.59% among Emirati, 19.71% among other Arabs and 54.37% among Asian 

Incidence rate of seasonal influenza in Dubai for the period 2017-2019 according to age distributions showed that 30.7%among students, and 7.8%among children preschool age, and 5.22%among housewives is as shown by table(1). The present study showed that the incidence rate of seasonal influenza in Dubai in 2017-2019 as per moth distributions was the highest, 21.4%in November followed by 18.2%in December, and the least was 2% in July. The study found that total cases of seasonal influenza infection in Dubai for the period 2017-2019 as per year quartile showed that quarter one (Q1) showed 8845 cases, quarter two (Q2) revealed 3195 cases, quarter three (Q3) showed 2254 and quarter four (Q4) showed 14564 case as shown in figure (5).

Table 1: Socio-demographic charechertstics of seasonal Influenza among Dubai population 2017-2019
Figure 1: Incidence rate per 100000 population of seasonal Influenza among Dubai population 2017-2019
Figure 2: Age distribution of seasonal influenza incidence rate Among Dubai Population 2017-2019
Table 2: Statistical values around Seasonal influenza patients ages 2017-2019
Table 3: Seasonal influenza incidence rate per 100000 of population According to nationalities in Dubai 2017-2019
Figure 3: Seasonal influenza incidence rate per 100000 of population According to the months of the year in Dubai 2017-2019

Discussions

The current study showed that the incidence rate of seasonal influenza incidence rate among Dubai population in 2019 was 466 case per100000 population, more among male comparing to females and highest in December. This finding is similar to the other studies finding in Saudi Arabia [5, 6, 7] which revealed that, 733 (53.8%) male and 629 (46.2%) female patients with ARI who visited the health care centers between November 2015 and February 2018. The ‐PCR test revealed an overall positivity rate of 37.2% (507/1362). The positive rate increased during winter; it was highest in December and lowest in September.

Other studies finding regarding seasonality of the diseases found to be in agreement with current study findings [8,9,10 ], which revealed that similar seasonality pattern on respiratory viral infection rates was observed in our study.  Influenza was the main contributing organism to the seasonal pattern; the subtypes A/H1N1/pdm09 and influenza B contributed predominantly to the winter peak. Low temperatures and low specific humidity during the winter season in the UAE may be the cause of the peak in the number of influenza like illnesses in the winter. In addition to the major peak in the winter, a small peak in August was also observed for influenza (semi‐seasonal pattern), which parallels the patterns reported from temperate and tropical countries in the Northern Hemisphere.

The current study conclude similar results comparing to other studies carried out in Egypt, Jordan , Oman and yamen [ 11 ], regarding seasonal influenza rate by age. The available data showed that, the majority of the cases (96%) were under 5 years of age. The highest incidence among younger age group concluded in this study was similarly found in other study in china, yet in china study found that the incidence rate was among the highest rates in all age groups. Such finding can be explain by lack of preventive and hygienic precautions by younger age groups from one side and from other sides low and less maturity of immune system in young age groups [12].

As the current study Reflected that ethnicity groups showed different incidence rate, this finding could come with explanation that ethnicity may be linked to individuals and groups behaviors as well as some genetic element which can put some ethnicities at high risk of exposure, this finding was found to be similar to the other studies finding that revealed influenza transmission is constrained by contact patterns, which are influenced by individual behavior and sociological events. For example, the closing of schools for the two-week Holy Week period likely hampered the early transmission of H1N1/09 in Mexico City and the subsequent implementation of social distancing interventions including school closures. These events prevented contacts that typically take place within schools that are thought to be pivotal to spread of flu through communities. The reverse is also true: the dynamics of infectious diseases can dramatically alter the structure of a host population [13, 14, 15, and 16].

•           Study Limitations:

-           The data utilized was mainly driven from private sector statistics, as public sector reporting was inadequate.

-           Behavioral risk factors related to spreading of seasonal influenza were not well addressed due to being secondary accumulated data gathered for statistical documentation peruses.

-           Lack of full information specially that one related to clinical lay out of the cases.

•           Study strengths:

 The study sample was   big enough to obtain good conclusions.

Future Researches:

 Future research will be of great benefits on seasonal influenza in Dubai if focusing on:

-           Clinical outcome and complications rates of seasonal influenza in Dubai

-           Morbidities and mortalities among High risk groups in Dubai.

-           Gaps in Vaccination coverages

Conclusions

The current study concluded that, the incidence rate of seasonal influenza in Dubai keep increasing during the last three years, yet the annual increment is not alarming, the highest rates significantly come from children segment of population specially students and elderly group as well, the period from October to end of February of each years showed the highest rate of seasonal influenza incidence.

Policy implications

Gaps in preventions like promoting healthy behaviors, bridging vaccination coverage gaps, focusing on high risky groups, strengthening influenza surveillance program and improving public health response measures.

Ethical issues

Ethical standard procedures we applied to the best of possible throughout all stages of the research

Conflict of Interests:

All authors declared that there are no conflict of interest.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad